RESPONSIBILITIES

Process new claims or modify existing claims according to the appropriate and applicable action Analyze claims to determine appropriate action to approve or deny a claim for payment Determine accurate payment criteria for clearing pending claims based on defined policies and procedures Research claims edits to determine appropriate benefit application utilizing established criteria; apply physician contract pricing as needed for entry-level claims Review and address provider inquiries regarding claim adjudication Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards

 

QUALIFICATIONS

2 to 5 years of medical claims processing experience Knowledge in US healthcare practice, medical coding (ICD-10, CPT4, DRG, HCPCS), clinical documentation improvement, medical terminologies, EDI - HIPAA protocol Ability to multi-task and follow documented claims processes with minimal supervision Excellent verbal and written business communication skills Experience in medical coding, including diagnosis coding and terminology, is an advantage Bachelor’s Degree, preferably in Healthcare and Allied Medical Profession. Credential/Professional Certification related to current work is an advantage Strong attention to detail and the ability to make appropriate decisions based on information presented Ability to work on high volume of repetitive claims